Epileptics in high-crime neighborhoods have three times as many seizures

People with epilepsy living in high crime neighborhoods in Chicago had three times as many seizures as those living in neighborhoods with lower crime rates according to new research from the University of Illinois at Chicago presented at the American Epilepsy Society 2018 conference in New Orleans.

Epilepsy is a chronic neurological disorder characterized by abnormal brain activity and seizures that affects more than 65 million people worldwide. About one-third have difficulty controlling their seizures even with medication. Seizures can interfere with work, relationships, and the ability to live independently. Previous research has shown that living in neighborhoods with high rates of crime have significantly higher levels of the stress hormone, cortisol. Stress is also a factor that is commonly reported to trigger seizures in people with epilepsy.

The UIC study included 63 adults with epilepsy living within the city limits of Chicago who were participating in a larger study testing the efficacy of a tablet-based educational tool that provides tailored information about epilepsy. That study, called PAUSE, involves patients at the University of Illinois Hospital’s epilepsy clinic and in the Chicagoland community and is facilitated by the Epilepsy Foundation of Greater Chicago.

The researchers determined the levels of crime in neighborhoods of the 63 participants by mapping their zip codes to specific neighborhoods and then cross-referencing those neighborhoods with local crime rates available through the City of Chicago Police data portal. Participants self-reported the number of seizures they had in the past month and in the past three months.

“We found that people living with epilepsy who live in high-crime neighborhoods experienced significantly more seizures,” said Jessica Levy, a research coordinator in the UIC department of neurology and rehabilitation who presented the findings. “On average, people in high-crime neighborhoods had three seizures versus one for people living in low-crime neighborhoods when we looked back over the last 30 days. Over the course of 90 days, people in high-crime neighborhoods had seven seizures on average compared to three for those living in low-crime neighborhoods, so the link between crime and seizure activity is significant.”

The researchers found no overall association between neighborhood crime status and the duration of epilepsy or between crime status and poverty.

Having more seizures can significantly lower quality of life. Seizures that result in falls can cause bruising or even broken bones. There can also be a stigma associated with having a seizure in public.

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Many patients diagnosed with adenomas may not receive colonoscopies in recommended time frame

Patients who are diagnosed with adenomas, a possible precursor of colorectal cancer, often do not receive subsequent colonoscopies within the recommended time frame.

The study is published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, by Jessica Chubak, Ph.D., senior scientific investigator at Kaiser Permanente Washington Health Research Institute.

Adenomas are a type of polyp that can potentially become cancer. A person’s risk of cancer is higher if they have been diagnosed with certain types of adenomas, or if they have large or numerous adenomas, Chubak explained.

“When a patient is found to have some of these higher-risk findings, guidelines recommend that they come back for another colonoscopy in three years. This is called surveillance colonoscopy, and it improves our chances of preventing colorectal cancer or detecting it at an early stage,” Chubak said.

In this study, Chubak and colleagues analyzed patterns and factors associated with the receipt of colonoscopy within approximately three years of a diagnosis of high-risk adenoma or adenomas. The study was part of the National Cancer Institute (NCI)-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium, a multi-site program aimed at evaluating cancer screening processes.

Researchers studied 6,909 patients ages 50 to 89 who had received a colonoscopy at which one or more high-risk adenomas were discovered. The patients had been treated at one of three Kaiser Permanente systems, or Parkland Health & Hospital System, a safety-net system that treats patients regardless of their insurance status or ability to pay. The researchers used electronic health records data to identify patients who had been diagnosed with high-risk findings during initial (index) colonoscopies, and to ascertain whether they had received subsequent colonoscopies within the next three years.

The study found that in the three Kaiser Permanente systems, between 47 percent and 59.5 percent of study participants received a subsequent colonoscopy within six months to three and a half years after the colonoscopy with high-risk findings. At the Parkland safety-net system, 18.3 percent received the subsequent colonoscopy during the recommended time frame.

Chubak said the significantly lower rate at Parkland was most likely due to differences in resources and patient populations. She said differences among the Kaiser Permanente systems may reflect organizational differences, such as patient outreach procedures, medical center capacity, or ease of scheduling. She added that the challenge of delivering timely surveillance colonoscopies is widespread; studies in other systems and settings have also found that many patients do not receive colonoscopies during the recommended time frame.

Chubak noted that, at the time of the study, Kaiser Permanente did not have a centralized surveillance program, but has since implemented a comprehensive system for improving surveillance. Also, the Parkland system has since implemented a system to ensure that patients with these types of adenomas receive recommendations to come for surveillance colonoscopy within three years. Chubak and her fellow researchers expect to study these changes in the future.

The researchers identified several patient-related factors associated with timely receipt of a subsequent colonoscopy. Patients who had been diagnosed with more adenomas or whose adenomas had certain high-risk histologies were more likely to get the subsequent colonoscopy in the recommended time frame. Age was another factor; study participants aged 60-74 were more likely than the reference age group of 50- to 54-year-olds to get timely colonoscopies, and those aged 80-89 were less likely.

Chubak said this study supports the need for health care professionals to make sure patients are aware of all recommended screening guidelines, and to provide support when possible.

“We encourage patients and health care providers to talk about how and when to test for colorectal cancer, and we encourage health care systems to find ways to support patients and providers in following the guidelines,” she said. “In the future, it will be important to understand what types of reminders work best for different patient populations and in different health care settings.”

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Many drugstores won’t dispense opioid antidote as required

(HealthDay)—People who overdose on opioids have one lifeline, the drug naloxone, but two new studies find that many pharmacies won’t offer this lifesaving antidote without a doctor’s blessing.

Though many states have passed laws mandating that naloxone be made available without a prescription, researchers from California found that fewer than 25 percent of pharmacies in that state would give the drug without a prescription. And in the second study from Texas, investigators found that although 8 in 10 drugstores would dispense the drug, less than 7 in 10 had naloxone in stock.

Why? A lack of training, a lack of desire to make room for the drug on their shelves, and outright moral objections to giving an opioid user a medication that might encourage drug abuse, the scientists said.

“We have an opioid crisis in our country, and we have a large number of opioid overdose deaths, about half of which are due to prescription opioids,” said Talia Puzantian, lead researcher of the first study, and associate professor of clinical sciences at Keck Graduate Institute School of Pharmacy and Health Sciences in Claremont, Calif.

People getting prescriptions for these narcotic painkillers may not think they are at risk for overdosing, she said. “But these drugs have significant safety issues,” Puzantian said.

Part of a pharmacist’s role is to educate patients about the dangers of opioids and make naloxone available when they think the patients may be at risk for an overdose, she said. These include people who are taking high doses of the painkillers or are mixing them with other drugs that can increase the risk.

Since 2016, California law has allowed pharmacists to provide naloxone without a prescription.

For the California study, Puzantian and her colleagues called more than 1,100 pharmacies asking if they would provide naloxone without a physician’s prescription. Fewer than 25 percent said they would. Of those, only about 50 percent stocked nasal spray naloxone, the researchers found.

Puzantian said that pharmacists need to be taught about the law allowing them to give patients naloxone without a prescription.

In addition, they need to have the drug on hand. Many pharmacies that don’t stock naloxone said they didn’t have the shelf space, given all the other more popular drugs they need to carry and the low demand for naloxone.

Some pharmacists have a moral objection to providing drugs to opioid users, Puzantian said. They believe that it only encourages drug abuse, but that’s not the case, she said.

“Opioid overdoses don’t only occur in people using heroin, so patients should talk with their pharmacists about whether they are at risk for overdose and whether they might be a good candidate for having naloxone on hand,” Puzantian said.

In the second study, researchers led by Kirk Evoy, a clinical assistant professor at the University of Texas at Austin, studied the availability of naloxone at chain pharmacies in the state. Texas also allows pharmacists to provide the drug without a prescription.

Of the 2,300 drugstores contacted, 84 percent said they would provide the drug, but only 69 percent had it on their shelves. The nasal spray form of the drug was the one most commonly available, the researchers found.

In drugstores that had the drug in stock and would provide it without a prescription, patients could walk into the pharmacy without having seen a doctor and obtain naloxone the same day in approximately 70 percent of the chain pharmacies contacted, Evoy said.

Although chain stores like CVS and Walmart stock naloxone, more need to make the drug available, he said.

“Hopefully, this study serves as a call to action for community pharmacies to better educate their pharmacists and support staff regarding naloxone access laws and company policies regarding naloxone dispensing,” Evoy said.

Dr. Sandeep Kapoor, director of screening, brief intervention and referral to treatment at Northwell Health in New Hyde Park, N.Y., said the public also needs to be educated about naloxone.

“We need to encourage education for the community, schools and hospitals to relieve apprehensions one may feel in going directly to a pharmacy to get naloxone,” said Kapoor, who was not involved with the studies.

It might be that people feel uncomfortable asking for naloxone because of fear or the stigma associated with opioid use, he said.

“We should continue identifying barriers to utilization and focus efforts to further normalize and destigmatize substance use disorder,” Kapoor said.

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It is estimated how many years after quitting Smoking normal health

Quitting Smoking took more than 15 years to the risk of developing cardiovascular disease have returned to the level of those who never smoked. This is indicated by the results of the preliminary research presented recently in Chicago at the Scientific sessions of the American heart Association (American Heart Association).

Previous studies have shown that the risk of cardiovascular disease in smokers is reduced a few years after they quit Smoking. However, previously it was not possible to trace the history of Smoking participants to note changes in the frequency of Smoking or evidence of relapse of Smoking.

In the new study, the researchers analyzed history of Smoking over a lifetime of about 8700 participants of the Framingham study (Framingham Heart Study), whose early studies have not yet been cardiovascular diseases. The average for the participants in the study were followed for 27 years. At the same time, the researchers compared the risk of cardiovascular disease in smokers, non-smokers and ex-smokers.

As a result, the researchers found that:

  • More than 70% of cases of cardiovascular disease in smokers or former smokers was observed in those who smoked a pack a day for 20 years.
  • Former smokers who quit within the past five years, the risk of developing cardiovascular disease fell by 38% compared with those who continued to smoke.
  • Overall it took 16 years from the date of refusal of Smoking to the risk of developing cardiovascular disease in former smokers returned to the same level as those who never smoked.

These results emphasize that some benefits of quitting can be seen during the first five years, as 38% reduced risk of heart attack and stroke compared with people who continue to smoke. We also found that the risk of cardiovascular disease remains elevated for 16 years after people quit Smoking compared with people who never smoked. The conclusion of the study is that if you smoke, now is a good time to quit, says Meredith Duncan, (Meredith Duncan), author of the study from the Medical center of Vanderbilt University (Vanderbilt University Medical Center) in Nashville, Tennessee.

Dmitry Kolesnik